European journal of trauma and emergency surgery : official publication of the European Trauma Society最新文献

{"title":"Implant removal associated complications after ESIN osteosynthesis in pediatric fractures.","authors":"Justus Lieber,&nbsp;Markus Dietzel,&nbsp;Simon Scherer,&nbsp;Jürgen F Schäfer,&nbsp;Hans-Joachim Kirschner,&nbsp;Jörg Fuchs","doi":"10.1007/s00068-021-01763-4","DOIUrl":"https://doi.org/10.1007/s00068-021-01763-4","url":null,"abstract":"<p><strong>Purpose: </strong>ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal.</p><p><strong>Methods: </strong>A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed.</p><p><strong>Results: </strong>The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance.</p><p><strong>Conclusion: </strong>Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth.</p><p><strong>Evidence: </strong>Level III, retrospective.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3471-3478"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39269539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital preparedness for mass gathering events and mass casualty incidents in Matera, Italy, European Capital of Culture 2019.","authors":"Erasmo Roberto Campanale,&nbsp;Margherita Maragno,&nbsp;Gaetano Annese,&nbsp;Angela Cafarelli,&nbsp;Rosario Coretti,&nbsp;Josepmaria Argemì,&nbsp;Maria Teresa Cibelli,&nbsp;Riccardo Sannicandro,&nbsp;Carl Montan,&nbsp;Roberto Faccincani","doi":"10.1007/s00068-021-01775-0","DOIUrl":"https://doi.org/10.1007/s00068-021-01775-0","url":null,"abstract":"<p><strong>Introduction: </strong>Mass Casualty Incidents (MCI) may occur during Mass Gathering Events (MGE). A failure to prepare and train the health care system for potential MCI, can cause chaos and delays in the response, leading to an increased morbidity and mortality. Education and training of staff are crucial for preparedness. In Italy, hospital Emergency Plans for Massive Influx of Injured (in Italian designated with the acronym PEMAF) are mandatory since the '90's. However, when available, they are usually poorly known by the staff, rarely reviewed and validated. In 2014, Matera, a city in Southern Italy, was designated as the European Capital of Culture for 2019. As a result, we took this opportunity to revise the \"Madonna delle Grazie\" PEMAF and to start a program for increasing the awareness of the plan among the medical staff and provide specific training for MCI management.</p><p><strong>Material & methods: </strong>The PEMAF was reviewed through simulations that involved the entire staff. A partnership with the International Association for Medical Response to Major Incidents & Disasters (MRMI) led to the support of experts and to the organization of residential courses based on the MAss Casualty SIMulation tool (MACSIM®). In total, six residential educational events of MACSIM-PEMAF were organized. Individual capacity was tested before and after the education through self-administered semi-quantitative questionnaires.</p><p><strong>Results: </strong>All the available resources were mapped and the functional areas identified. Alert, coordination and command sequences were defined. The communication network was improved. Documentation and registration systems were developed. Standard operational procedures (action cards) were created for the key positions. The knowledge and capacity to function in active roles during a MCI was improved among the participants in the educational program.</p><p><strong>Conclusions: </strong>MGE are great opportunities for the development of the hosting community but also represent an increased risk of MCI. Preparedness is mandatory for health care systems. The educational format MACSIM-PEMAF seems to be adequate to review and improve the existing plans and transfer specific skills to attendants.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3831-3836"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-021-01775-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic options for blunt abdominal trauma.","authors":"Gerhard Achatz,&nbsp;Kerstin Schwabe,&nbsp;Sebastian Brill,&nbsp;Christoph Zischek,&nbsp;Roland Schmidt,&nbsp;Benedikt Friemert,&nbsp;Christian Beltzer","doi":"10.1007/s00068-020-01405-1","DOIUrl":"https://doi.org/10.1007/s00068-020-01405-1","url":null,"abstract":"<p><strong>Purpose: </strong>Physical examination, laboratory tests, ultrasound, conventional radiography, multislice computed tomography (MSCT), and diagnostic laparoscopy are used for diagnosing blunt abdominal trauma. In this article, we investigate and evaluate the usefulness and limitations of various diagnostic modalities on the basis of a comprehensive review of the literature.</p><p><strong>Methods: </strong>We searched commonly used databases in order to obtain information about the aforementioned diagnostic modalities. Relevant articles were included in the literature review. On the basis of the results of our comprehensive analysis of the literature and a current case, we offer a diagnostic algorithm.</p><p><strong>Results: </strong>A total of 86 studies were included in the review. Ecchymosis of the abdominal wall (seat belt sign) is a clinical sign that has a high predictive value. Laboratory values such as those for haematocrit, haemoglobin, base excess or deficit, and international normalised ratio (INR) are prognostic parameters that are useful in guiding therapy. Extended focused assessment with sonography for trauma (eFAST) has become a well established component of the trauma room algorithm but is of limited usefulness in the diagnosis of blunt abdominal trauma. Compared with all other diagnostic modalities, MSCT has the highest sensitivity and specificity. Diagnostic laparoscopy is an invasive technique that may also serve as a therapeutic tool and is particularly suited for haemodynamically stable patients with suspected hollow viscus injuries.</p><p><strong>Conclusions: </strong>MSCT is the gold standard diagnostic modality for blunt abdominal trauma because of its high sensitivity and specificity in detecting relevant intra-abdominal injuries. In many cases, however, clinical, laboratory and imaging findings must be interpreted jointly for an adequate evaluation of a patient's injuries and for treatment planning since these data supplement and complement one another. Patients with blunt abdominal trauma should be admitted for clinical observation over a minimum period of 24 h since there is no investigation that can reliably rule out intra-abdominal injuries.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3575-3589"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-020-01405-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38083757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olecranon fractures in children: treatment of a rare entity.","authors":"Miriam Kalbitz,&nbsp;Birte Weber,&nbsp;Ina Lackner,&nbsp;Meinrad Beer,&nbsp;Jochen Pressmar","doi":"10.1007/s00068-020-01518-7","DOIUrl":"https://doi.org/10.1007/s00068-020-01518-7","url":null,"abstract":"<p><strong>Background: </strong>Olecranon fractures are a rare entity in children. The classification and treatment strategies are still discussed controversially.</p><p><strong>Methods: </strong>A retrospective chart review of all patients < 17 years admitted with an olecranon fracture at a Level I Trauma Center between 2005 and 2017 has been performed. 46 subjects were included. For classification of olecranon fractures in children the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF) was used. Fractures were classified along the fracture line, dislocation, joint involvement and affection of the apophysis. For statistical analysis, a comparison of two groups was performed using Student t test. One-way ANOVA and Tukey's multiple comparison test was used to identify differences between more than two groups. For all analysis p ≤ 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The mean age of the children was 8.5 years (2-16 years). Most children were treated with a conservative therapy (n = 29, 63.0%). 17 patients (36.9%) underwent osteosynthesis (plate or tension band wiring) of which three were initially treated with a conservative therapeutic approach. Children with operative treatment were significantly older compared to children treated conservatively. Interestingly, all patients with luxation were characterized by an oblique fracture line, one of them extraarticular, three intraarticular.</p><p><strong>Conclusion: </strong>Taken together, this study analyzed one of the largest selections of pediatric patients with olecranon fracture in regard to fracture type and treatment strategy. Based on the assumption that treatment strategies follow a fracture classification, a consistent classification method is needed which should take into account fracture morphology and localization, as considered by the AO-PCCF, and the dislocation as measured by Braque. Surgical treatment is needed in case of dislocation ≥ 5 mm, intra-articular fractures, instable fracture conditions caused by the fracture line, open fractures and the affection of the apophysis. Otherwise, the conservative treatment shows insufficient results in the elbow mobility. The reliable choice of treatments based on our classification was mirrored by the very low rate of conversion of treatment strategies.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3429-3437"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-020-01518-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38636228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients.","authors":"Nils Jan Bleeker,&nbsp;Nicole M van Veelen,&nbsp;Bryan J M van de Wall,&nbsp;Inger N Sierevelt,&nbsp;Björn-Christian Link,&nbsp;Reto Babst,&nbsp;Matthias Knobe,&nbsp;Frank J P Beeres","doi":"10.1007/s00068-021-01836-4","DOIUrl":"https://doi.org/10.1007/s00068-021-01836-4","url":null,"abstract":"<p><strong>Introduction: </strong>Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered to be feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia.</p><p><strong>Materials and methods: </strong>All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated between January 2012 and September 2019 either with MIPO or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent surgeries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities.</p><p><strong>Results: </strong>A total of 135 patients were included out of which 72 patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with IMN (13 (22%) vs. 4 (6%), p = 0.04). There was no significant difference between both groups in terms of rotational malalignment (3% vs. 10%) and angular malalignment (4% vs. 5%). A significantly higher rate of infection was found after MIPO after correction of significant differences in baseline characteristics. No differences were found in subsequent surgeries or functional outcomes.</p><p><strong>Conclusion: </strong>Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union, whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3683-3691"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39874911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualization of complicated fractures by 3D-printed models for teaching and surgery: hands-on transitional fractures of the ankle.","authors":"Jonas Neijhoft,&nbsp;Dirk Henrich,&nbsp;Katharina Mörs,&nbsp;Ingo Marzi,&nbsp;Maren Janko","doi":"10.1007/s00068-022-01879-1","DOIUrl":"https://doi.org/10.1007/s00068-022-01879-1","url":null,"abstract":"<p><strong>Aims: </strong>Understanding the orientation of fracture lines and mechanisms is the essential key to sufficient surgical therapy, but there is still a lack of visualization and teaching methods in traumatology and fracture theory. 3D-printed models offer easy approach to those fractures. This paper explains the use of the teaching possibility with 3-dimensional models of transitional fractures of the ankle.</p><p><strong>Methods and results: </strong>For generating 3D printable models, already obtained CT data were used and segmented into its different tissues, especially parts concerning the fracture. After the segmentation process, the models were produced with FFF (fused filament fabrication) printing technology. The fracture models then were used for hands-on teaching courses in AO course (Arbeitsgemeinschaft für Osteosynthesefragen) of pediatric traumatology in 2020 in Frankfurt. In the course fracture anatomy with typical fracture lines, approaches, and screw placement could be shown, discussed and practiced.</p><p><strong>Conclusion: </strong>The study shows the use of 3D-printed teaching models and helps to understand complicated fractures, in this case, transitional fractures of the ankle. The teaching method can be adapted to numerous other use cases.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3923-3931"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modification of the TRISS: simple and practical mortality prediction after trauma in an all-inclusive registry.","authors":"Mitchell L S Driessen,&nbsp;David van Klaveren,&nbsp;Mariska A C de Jongh,&nbsp;Luke P H Leenen,&nbsp;Leontien M Sturms","doi":"10.1007/s00068-022-01913-2","DOIUrl":"https://doi.org/10.1007/s00068-022-01913-2","url":null,"abstract":"<p><strong>Purpose: </strong>Numerous studies have modified the Trauma Injury and Severity Score (TRISS) to improve its predictive accuracy for specific trauma populations. The aim of this study was to develop and validate a simple and practical prediction model that accurately predicts mortality for all acute trauma admissions.</p><p><strong>Methods: </strong>This retrospective study used Dutch National Trauma Registry data recorded between 2015 and 2018. New models were developed based on nonlinear transformations of TRISS variables (age, systolic blood pressure (SBP), Glasgow Coma Score (GCS) and Injury Severity Score (ISS)), the New Injury Severity Score (NISS), the sex-age interaction, the best motor response (BMR) and the American Society of Anesthesiologists (ASA) physical status classification. The models were validated in 2018 data and for specific patient subgroups. The models' performance was assessed based on discrimination (areas under the curve (AUCs)) and by calibration plots. Multiple imputation was applied to account for missing values.</p><p><strong>Results: </strong>The mortality rates in the development and validation datasets were 2.3% (5709/245363) and 2.5% (1959/77343), respectively. A model with sex, ASA class, and nonlinear transformations of age, SBP, the ISS and the BMR showed significantly better discrimination than the TRISS (AUC 0.915 vs. 0.861). This model was well calibrated and demonstrated good discrimination in different subsets of patients, including isolated hip fractures patients (AUC: 0.796), elderly (AUC: 0.835), less severely injured (ISS16) (AUC: 878), severely injured (ISS ≥ 16) (AUC: 0.889), traumatic brain injury (AUC: 0.910). Moreover, discrimination for patients admitted to the intensive care (AUC: s0.846), and for both non-major and major trauma center patients was excellent, with AUCs of 0.940 and 0.895, respectively.</p><p><strong>Conclusion: </strong>This study presents a simple and practical mortality prediction model that performed well for important subgroups of patients as well as for the heterogeneous population of all acute trauma admissions in the Netherlands. Because this model includes widely available predictors, it can also be used for international evaluations of trauma care within institutions and trauma systems.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3949-3959"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39935867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis.","authors":"Michiel Herteleer,&nbsp;Mehdi Boudissa,&nbsp;Alexander Hofmann,&nbsp;Daniel Wagner,&nbsp;Pol Maria Rommens","doi":"10.1007/s00068-021-01625-z","DOIUrl":"https://doi.org/10.1007/s00068-021-01625-z","url":null,"abstract":"<p><strong>Introduction: </strong>In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO.</p><p><strong>Results: </strong>48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO.</p><p><strong>Conclusion: </strong>There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3711-3719"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-021-01625-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25462977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Important learning points arising from the focused issue dedicated to the Terror and Disaster Surgical Care (TDSC®) course on mass casualty incident management.","authors":"Itamar Ashkenazi,&nbsp;Per Örtenwall,&nbsp;Fernando Turégano Fuentes","doi":"10.1007/s00068-021-01600-8","DOIUrl":"https://doi.org/10.1007/s00068-021-01600-8","url":null,"abstract":"<p><p>The Terror and Disaster Surgical Care (TDSC®) course on mass casualty incident management was formulated in Germany by military medical personnel, who have been deployed to conflict areas, but also work in hospitals open for the lay public. In this manuscript we discuss different concepts and ideas taught in this course as these are described in a focused issue recently published in the European Journal of Trauma and Emergency Surgery. We provide reinforcement for some of the ideas conveyed. We provide alternative views for others. Injuries following explosions are different from blunt and penetrating trauma and at times demand a different approach. There are probably several ways to manage a mass casualty incident depending on the setup of the organization. An open discussion on the topics presented in the manuscripts included in the focused issue on military and disaster surgery should enrich everyone.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"3593-3597"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-021-01600-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38786737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume-outcome relationships in laryngeal trauma processes of care: a retrospective cohort study.","authors":"David Forner,&nbsp;Christopher W Noel,&nbsp;Matthew P Guttman,&nbsp;Barbara Haas,&nbsp;Danny Enepekides,&nbsp;Matthew H Rigby,&nbsp;S Mark Taylor,&nbsp;Avery B Nathens,&nbsp;Antoine Eskander","doi":"10.1007/s00068-022-01950-x","DOIUrl":"https://doi.org/10.1007/s00068-022-01950-x","url":null,"abstract":"<p><strong>Purpose: </strong>The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma.</p><p><strong>Methods: </strong>This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized.</p><p><strong>Results: </strong>In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29-2.90]) and third (OR 1.67 [95% CI 1.08-2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile.</p><p><strong>Conclusion: </strong>Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4131-4141"},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}